Merchant Application

The secure form below will get us started on your set up.

Champion Payments Account Application

Fill out the secure form below and we will get you set up ASAP. Don't forget the 2 file uploads!

Business Name *

Business DBA *

Business Entity Type *

Business EIN *

Business Start Date *

State of Entity Registration *

Business Phone *

Address *

Business Street Address

City

State

Country

Postal code

Website

Estimated Monthly Credit Card Volume *

$

Estimated Average Ticket *

$

Estimated High Ticket *

$

Percent of Keyed Credit Card Transactions *

Signer's First Name *

Signer's Last Name *

Signer's Phone *

Signer's Email *

Signer's Social Security Number *

Signer's Date of birth *

Signer's Home Address *

Signer's Home City, State, and Zip *

Business Bank Name *

Business Bank Routing Number *

Business Bank Account Number *

Signer's Drivers License

Scan/Photo of Signer's Drivers License

Voided Check

Scan/Photo of Voided Business Check

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Contact

[email protected]

(800) - 962 - 5908